Common_problems_in_neonates.pptx which occur in day today care

Common problems in neonate which can be seen in day today clinical practice

1. Wel-come

2. Common problems in neonatal office practice

3. 3 DOL baby Delivered by normal vaginal delivery Given BCG, OPV, Hep B Developed rash over body Baby active , feeding well

4. Parents complaining “ post vaccination side effect ” ???

5. Erythema toxicum Very common rash occurs in almost 50 % of neonates Small white/ yellow papules on red base seen on face , trunk, and limbs. Sparing palms and soles. Usually develop 2-3 days after birth Self limiting Requires assurance

6. DOL 2 Female child Mother noted bluish colour discolouration on back. Is it going to be there life long??? How to treat it?

7. Mongolian spot Infiltration of melanocytes deep in dermis. Blue to blue-black macules occur anywhere on the body , mostly on the back and buttocks. Often fade within 1 st few yrs. due to decreasing transparency of skin rather than true disappearance.

8. Strawberry(capillary) hemangioma Common type of vascular birthmark. Painless and harmless Unknown cause. Consist of small, closely packed blood vessels. May develop few weeks after birth . Topical steroids and oral beta blockers can be tried . Laser treatment. May disappear by time by 9yrs.

9. Port- wine stain Initially flat and pink later deepen to dark red or purplish color with age. Seen mostly on face Consists of superficial and deep dilated capillaries in the skin Can be associated with brain lesion (sturge weber syndrome). It can be removed by laser.

10. New born baby Mother noticed red colored eye

11. Subconjuctival hemorrhage Bleeding underneath and conjunctiva Appears as bright red patch in sclera. Painless and harmless. Usually resolves with in 1-2 weeks.

12. Dol 3 Mother noticed red colored urine on diaper On examination PV bleed Parent’s worried What next?

13. Vaginal bleeding Menstrual like bleeding due to withdrawal of maternal estrogen. Bleeding occurs 3-5 days of birth. Mild last for 2-4 days. Assurance is advised. If bleeding is large might require investigation of bleeding disorder

14. Parents noticed breast engorgement in neonates

15. Parents noticed breast engorgement in neonates Aaya squeezed it to drain milk 3 day later

16. Breast Engorgement Bilateral fullness of both breast. Overlying skin shows no signs of inflammations Resolves spontaneously, no intervention required. Due to high maternal hormones. Massage or squeezing the breast or nipples is not recommended

17. Dol 3 baby brought by relatives with c/o loose motion 6-8 times a day. Baby active passing urine 7-8/day. Sleep well after feed Baby passes motion after each feed Parents complaining, Baby not tolerating feed. Should we start AGE treatment???

18. Diarrhea Passage of motions 8-10 times /day in otherwise actively feeding baby is normal. Gastro-colic reflex. Put on exclusive breast feed. Avoid bottle feeding, maintain hygiene.

19. Vomiting Common problem Due to not burping properly GER, might require treatment some times. Any greenish vomiting is pathological.

20. Natal teeth Tooth those are present at birth Neonatal teeth, which grow in during the first 30 days after birth . In both cases, once erupted, teeth has to be extracted due to the danger of getting aspirated or may cause discomfort.

21. Umbilical granuloma It is ,moist, red lump (cystic lesion) of soft tissue seen at umbilicus after cord falls. Usually disappear spontaneously May persist Application of silver nitrate or common salt

22. Umbilical sespsis Purulent discharge Foul smell Periumbilical redness Baby lethargic, poor feeding Needs injectable /oral antibiotics along with cord care

23. Danger signs Poor feeding, lethargic/ irritability Rapid respiration, chest retractions, apnoea or grunting Cold to touch, fever Central cyanosis, Jaundice extending to palm and sole.

24. Danger signs - Contd.. Persistent vomiting, abdominal distension, Not passage of meconium within 24 hrs . Not passing urine within 48hrs Superficial infections like umbilical pus discharge Bleeding Poor weight gain

25. Management of ELBW Systematic and team approach

26. 650 gram female baby delivered at Bambawade by LSCS at 26 weeks of gestation.

27. Transportation Baby intubated at birth and transported to Saisparsh hospital

28. Baby put on ventilatory support Surfactant given on day 1. Management of RDS

29. Baby had poor perfusion on day 2 Managed by ionotropes ( Dobutamine and Dopamine). IVC and Cardiac contractility monitoring by in house USG machine. Umbilical venous catheter was secured Management of Shock

30. On day 4 th baby had tachycardia and bounding pulses Bedside 2 d echo done which was s/o large PDA Baby started on injection paracetamol and fluid restriction done. Management of PDA

31. On day 7 th, Baby was hemodyanamically stable and PDA was closed. Baby was extubated on day 7 th After extubation baby put on Nasal CPAP for next 3 weeks. Extubation

32. Baby started on trophic feeds on day 4th After extubation on day 7 th, feeds increased gradually. Till baby was on full feeds, baby was on Total parenteral nutrition. Baby achieved full feeds on day 18th. Management feeding

33. On day 21 baby had abdominal distension and brownish RTA Xray abdomen erect done bedside s/o NEC Baby again kept NBM TPN started PICC line secured Bowel rest given for 72 hours and feeds again started gradually Management of NEC

34. Again on day 34 th baby had repeated abdominal distension with regurgitation But CBC , electrolytes and xr a y abdomen erect was normal. P/A - soft Features s/o GERD We started baby on Gavage feeding ( continuous feeding) Management GERD

35. On day 32 nd Baby had increasing respiratory distress. CXR s/o BPD Baby was on blender O2 FiO2 requirement increased to 4 % Baby started on hydrochlorothiazide and inj. Dexamenthasone (low DART regimen) Gradually O2 requirement decreased and baby off O2 on day 6 0th Managent of BPD

36. Received PCV transfusion twice Anemia of Prematurity

37. ROP screening - Normal OAE, Neurosonogram screening, TSH - Normal Management of ROP

38. Baby discharged on day 95 Weight at the time of discharge - 1.6 kg Discharge

39. Case2 14 hrs old child, 34 weeks gestational age NVD, govt hospital, cried immediately after birth Shifted mother side Relatives c/o baby is lethargic, not accepting feeds referred to our hospital RR-100, HR -167, cyanosed spo2 70 with o2 np Intubated with o2 100 spo2 ,improved 92-95, labile saturations Pre ductal ,post ductal saturation difference >5

40. Management Ventilation Surfactant Milirinone along with vasopressor Monitoring by echo

41. TEAM WORK Safe Transport Protocol based Practice High end equipments – HFO, Ventilators, Bedside USG machine, ABG machine Hard work with continuous monitoring Key To Success

42. 1) Surgeries Any Surgery from birth till 18 years of life . 2) Common Surgeries Hernia Hydrocele Appendisectomy Tracheoesophageal fistula Diaphragmatic hernia Intestinal atresia....etc Paediatric Surgical Emergencies

43. 60 Beds Exclusive Paediatric Hospital with 10 Beds PICU & 35 Beds NICU 8 In house full time Paediatric & Neonatal Intensivist Expert & experienced team of Medical officers & Nursing staff Highly advanced equipments like HFO, Bedside USG machine, Mira cradle, bedside EEG Well equipped & spacious Operation theatre CM Relief fund ICU on wheels - Prompt Transport Facility - 3 well equipped ambulances Saisparsh children hospital